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Mail in form

*If you choose to submit your request online, please remember that if you select the default date of six days in the future, the effective date of the change will be made retroactive to the date the request was submitted. Should you select a date other than the default date, your change request effective date will not be changed.

**If you are mailing in your request, please note that you need to complete the sponsor section, the section related to the PCM change, the signature section and the Access to Care (ATC) section (if applicable). The change will become effective based on when the PCM change form is received.

Once your PCM change is processed, you will receive either an e-mail or postcard with instructions to access milConnect for the new PCM name and telephone number. All change requests are subject to the military hospital commander guidelines. PCM changes are effective based on when we receive the request: please do not seek services until you receive confirmation of the change.